Navigate:

Opinion Contributor

IPAB repeal not warranted

The author says the rules governing IPAB are far from perfect but repeal would be a serious blunder. |
Reuters
Close

By HENRY AARON | 7/14/11 9:50 PM EDT

The Independent Payment Advisory Board has come under a lot of criticism of late — including flat-out false allegations — from Republicans, whose declared objective is to repeal the entire health reform law, and Democratic members of Congress, who fear loss of congressional prerogatives. Both are wrong.

The IPAB is a central component of an integrated menu of provisions in the health reform legislation that promises to slow the runaway growth of health care spending. The rules governing the advisory panel are far from perfect — and amendments are called for — but repeal would be a serious blunder.

Text Size

-

+

reset

POLITICO 44

The IPAB is to be a board of 15, appointed by the president and confirmed by the Senate. The president must consult with members of Congress in the selection of 12 of the members. Far from being faceless bureaucrats, as critics allege, IPAB members will be fully vetted by the elected representatives of the people, and the chairman or chairwoman would be obliged to appear before any congressional committee that invited him or her — just as are members of the president’s Cabinet.

Once confirmed, IPAB members are charged with making recommendations on how to prevent Medicare spending per person from rising at excessive rates. These rates are set in a law that Congress enacted and can change at any time.

The law creating the IPAB clearly bars the panel from doing the things that critics now allege the IPAB will do. The IPAB is barred by law from rationing care; from raising taxes, premiums or cost sharing; and from restricting benefits or modifying eligibility.

So what can the IPAB do? The answer requires that one appreciate the range of the provisions in the health reform legislation to slow the growth of spending. The law sets up pilot programs and experiments to test new ways of organizing the delivery of care — the Accountable Care Organizations, for example or paying for care with bundled payments. It expands research on the relative effectiveness of different methods of treatment — comparative effectiveness analysis.

Each of these provisions — and many others — is intended to provide information on how to deliver care more effectively and efficiently. As of now, no one knows exactly how to bring ACOs into existence or make them work. No one knows how to bundle payments to provide incentives for high-quality, cost-efficient care. Comparative effectiveness analysis is needed because, rather surprisingly and very distressingly, most of what doctors and hospitals do has never been subjected to careful evaluation.

The insurance company bureaucrats wedged between patients and physicians are the only ones who deny and ration health care. Republicans lie about the IPAB, but ram insurance company death panels down the throats of the American people.

The insurance company bureaucrats wedged between patients and physicians, not the physicians, are the ones making the medical decisions for you.

If your physician says you need a treatment or surgery, and the insurance company bureaucrat wedged between you and your physician says you can't have it, you don't get it.

Rationing and death panels exist now, and have always existed, and they are made up of insurance company bureaucrats.

Politico writes "That is where the IPAB comes in. The law specifically authorizes the advisory board, among other things, to recommend changes in relative payments under Medicare for different forms of care. Such changes don’t ration care. Physicians would remain free to practice medicine as they wish. But changes in financial incentives can nudge both providers and patients to pay attention to the findings of research a bit sooner than they might otherwise."

By deciding what will, and will not be paid for the IPAB absolutely rations healthcare. The statement that "Physicians would remain free to practice medicine as they wish." seems to be contrary to the law if the following information from an article I read is true " Those physicians and hospitals that choose to practice individualized patient care in consultation with their patients will be punished because they are not “meaningful users of the system over time.” Beginning January 1, 2013 penalties for doing the right thing for a patient will cost the doctor $100,000 for the first offense and jail for the second offense. This will have a chilling effect and may be the straw that completely breaks the foundation of good medicine – the doctor patient relationship."

Obama said he thought we should not pay for expensive medical treatments for some seniors and just send them home with a pill. The IPAB will decide what treatments are too expensive, and when the only option a doctor has is to send someone home with a pain pill. That my friends is a death panel.

The insurance company bureaucrats wedged between patients and physicians are the only ones who deny and ration health care. Republicans lie about the IPAB, but ram insurance company death panels down the throats of the American people.

Please enlighten us as to what the republicans are lying about in regards to the IPAB. What is it that you don't understand about the principle that a government group deciding what medical procedures will and will not be paid for based strictly on the basis of cost is not a death panel.

The idea that insurance companies are the only ones who deny and ration healthcare is a mindless assertion. Take a close look at the medicare and medicaid programs and you will see that government rationing based on cost has been in place for years. Ask for government paid expensive medical care in some states and the state may not pay for your treatment, but they will offer to pay for your physician assisted suicide.

You're right Henry, IPAB should not be repealed, in fact, its role should be expanded. I think IPAB should set guidelines for grocery shopping, so we only buy healthy foods, and instructions on how to buy an automobile or truck, so we only buy efficient and safe cars, and maybe even what career to choose and courses to take. Why stop with just health care, when the field is wide open to have a dozen bureaucrats tell all Americans how to live their lives. Just think of what a paradise it would be - everyone would be healthy, slim, green and broke, living on the meager 5% of their incomes after all the local, state and Federal taxes are paid for the super Nanny State. Henry, Karl Marx and Lenin would be proud of you - you understand their noble motives entirely.

"The law specifically authorizes the advisory board, among other things, to recommend changes in relative payments under Medicare for different forms of care. Such changes don’t ration care."

How stupid does Mr. Aaron think the readers here are?

If payments to providers are cut for a service then that service winds up being rationed. It will only be provided to those that can pay privately for the service. That *is* rationing. There is no other way to view it.

Just like the $500 billion the Dems have already cut that's all they know for the future -- cut benefits while claiming that they are not doing that.

Mr. Arron declares that changes in reimbursement rates will encourage physicians to use more efficient procedures in practicing but will not discourage healthcare providers from using the best procedures for a specific patient.

If the physician determines that the best procedure for a specific patient has a cost in overhead of, say, $3,000. But, the IPAB determines that there is a less expensive procedure, that may cause blindness or paralysis in diabetic, only costs $1,000 and sets the reimbursement rate for treating this problem at $1,000, no exceptions. Wouldn't this IPAB decision effectively remove the better procedure from available to the patient? Mr. Arron, would you expect the health care provider to pay the additional $2000 for the better procedure out of their own pocket?

In the event that an insurance company denies a procedure the patient has recourse to the government regulators or even the judicial system. If a procedure is denied by the government regulator who can the patient apply to for third party evaluation? Does Mr. Arron expect the government will accept a lawsuit for malpractice? I have been in the military service and realize that a service member or his family cannot sue the government, if the government does not allow it.

There will always be a demand for more health care than the budget can pay for. The idea is to get as much as we can afford to pay for and distribute it rationally.

Beyond that, individuals are going to have to pay for exotic and unproven treatments themselves. That's the way it is now, except its the insurance companies who are saying things are "experimental" and therefore not covered.

You're right Henry, IPAB should not be repealed, in fact, its role should be expanded. I think IPAB should set guidelines for grocery shopping, so we only buy healthy foods, and instructions on how to buy an automobile or truck, so we only buy efficient and safe cars, and maybe even what career to choose and courses to take. Why stop with just health care, when the field is wide open to have a dozen bureaucrats tell all Americans how to live their lives. Just think of what a paradise it would be - everyone would be healthy, slim, green and broke, living on the meager 5% of their incomes after all the local, state and Federal taxes are paid for the super Nanny State. Henry, Karl Marx and Lenin would be proud of you - you understand their noble motives entirely.

Wow, I'm sure readling a lot of comments from folks that intend to die on the job. Well, obviously so. You can't retire on a fixed income and afford private insurance. Medicare will not be the same as it is today, I think we all understand that. You don't want the Affordable Care Act. All's that left is the voucher system of Mr. Ryan's which won't come close to covering a major event. Hint: When the elderly have a medical "event," it's usually major. So, obviously, you all plan to die on the job. You go!